【摘要】 目的比较右美托咪定与丙泊酚应用于患儿MRI检查镇静麻醉的有效性与安全性。方法将60例不配合MRI检查的患儿随机分为右美托咪定组（D组,n=30）和丙泊酚组（P组,n=30）。所有患儿入MRI准备室后予阿托品0.02 mg·kg^-1,iv;氯胺酮1.0 mg·kg^-1,iv。随后D组患儿予负荷量盐酸右美托咪定1μg·kg^-1,iv gtt,15 min输注完毕;然后予1μg·kg^-1·h^-1的维持量至检查结束。P组患儿予负荷量丙泊酚1 mg·kg^-1,iv;然后给予100μg·kg^-1·min^-1维持量至检查结束。记录2组患儿于入MRI准备室后（T0）、注射氯胺酮后1 min（T1）、右美托咪定及丙泊酚负荷量输注完毕即刻（T2）、输注维持量后15 min（T3）、检查结束时（T4）、苏醒即刻（T5）、离开复苏室即刻（T6）时记录血压、心率和SpO₂值,记录入睡时间、检查时间、复苏时间,以及呼吸抑制、术后躁动等不良反应的发生情况。结果 2组患儿均顺利完成MRI检查。P组患儿较D组入睡更快[（1.6±0.2）min vs（12.2±1.8）min,P<0.05],复苏时间更短[（47.4±6.3）min vs（54.1±9.1）min,P<0.05]。在面罩吸氧下,麻醉过程中P组患儿中有2例患儿出现短暂的呼吸抑制,SpO₂轻度下降,托起患儿下颌后即好转。D组患儿较P组患儿的心率下降更明显,但无心动过缓发生;P组患儿较D组患儿血压下降更明显,差异有统计学意义（P<0.05）。结论右美托咪定和丙泊酚均可为小儿MRI检查提供充分的麻醉。相比丙泊酚,右美托咪定组患儿入睡较慢,苏醒较慢,心率减低更明显,但更安全,血压稳定,无呼吸抑制发生。更多还原

【Abstract】 AIM To compare the safety and efficacy of dexmedetomidine and propofol applied in anesthesia for MRI examination in pediatric patients.METHODS A total of 60 pediatric patients undergoing MRI were randomized to receive either propofol（group P） or dexmedetomidine（group D）for anesthesia.All patients received atropine 0.02 mg·kg^-1,ketamine 1 mg·kg^-1 after arriving at the MRI preparation room.Then dexmedetomidine was administered at an initial loading dose(1 μg· kg^-1 for 10 min)followed by a continuous infusion(1 μg· kg^-1·h^-1).Propofol was administered at a bolus dose(1 mg·kg^-1) followed by a continuous infusion(100 μg·kg^-1·min ^-1).The values of HR,SBP,DBP and SpO₂ of the 2 groups were recorded in the MRI preparation room（TO）,1 min after injection ketamine（T1）,after infusion dexmedetomidine or propofol loading dose（T2）,15 min after the infusion of maintain volume（T3）,at the end of the examination（T4）,the time of wake up（T5） and leaving the recovery room（T6）.And the sleep time,the examination time,recovery time,postoperative restlessness,respiratory depression and other adverse reactions were recorded.RESULTS Two groups successfully completed the MRI examination.The patients of group P fell asleep faster than group D[（1.6 ± 0.2）min vs（12.2± 1.8） min],group D needed longer recovery time than group P[（54.1 ±9.1） min vs（47.4 ±6.3） min],and the difference was statistically significant（P < 0.05）.Under the oxygen mask,there were 2patients in the group P had transient respiratory inhibition,SpO₂ decreased slightly,which were improved after lifting with mandibular.The patients’ heart rate in group D decreased significantly than in group P,but no bradycardia happened.The patients’ blood pressure in group P decreased significantly compared with group D,the difference was statistically significant（P<0.05）.CONCLUSION Dexmedetomidine and propofol provide adequate anesthesia for pediatric patients undergoing MRI check.Compared with propofol,patients in group D fall asleep and wake up slowly.Dexmedetomidine leads to lower heart rate,but the blood pressure is more stable and safety without respiratory depression.更多还原